Midterm Practical Flashcards
Alignment cues
emphasizes achieving neutral trunk position in initial conditions
Directional Cues
motor responses influenced by stimulation of superficial somatosensory inputs gently guiding the patient in the direction of desired movement
Loading Cues
goal is to increase somatosensory input by a force through joint into the ground, recreating the GRF
Approximation Cues
Increasing somatosensory input by applying a gentle force through the long axis of the bone into the proximal joint to increase activity in the proximal muscles
Resistance Cues
manual application of force away from the axis of motion at the joints as patient is asked to move or to stabilize
Pelvic alignment cueing
goal is to facilitate lumbar extension and anterior pelvic tilt
Upright trunk alignment cueing
goal is to facilitate thoracic extension
Directional cueing for weight shift and scooting
goal is to offload one half of the pelvis to allow for shifting forward of that side
Directional cueing for lateral weight shift in standing
goal is to shift weight onto stance limb and offload opposite limb for gait/stepping/etc
Approximation cueing for foot placement in seated
goal is to engage the patient is actively offloading the distal extremity in seated for limb respositioning
Loading cueing for the lower extremity
goal is to increase muscle activity through the lower extremity in weight bearing tasks
MMT Rating 5
pt has full ROM against effects of gravity. examiner provides maximal resistance with no discernible difference between affected and unaffected limbs
MMT Grade 4
patient has full ROM against effects of gravity. examiner provides strong resistance with slight difference noted between affected and unaffected limbs
MMT Grade 3
Patient has full ROM against effects of gravity, but is unable to sustain any resistance offered by examiner
MMT Grade 2
Gravity eliminated: patient is able to produce full AROM
MMT Grade 1
gravity eliminated: patient is unable to produce full AROM, but muscle tension is palpable
MMT Grade 0
gravity eliminated: patient unable to initiate AAROM and muscle tension is not palpable
C5 Nerve Root
Elbow flexion
Shoulder Abduction
C6 Nerve Root
Wrist Extension
C7 Nerve Root
Elbow extension
C8 Nerve Root
Finger flexion
T1 Nerve Root
Finger abduction
L2 Nerve Root
hip flexion
L3 Nerve Root
knee extension
L4 Nerve Root
ankle dorsiflexion
L5 Nerve Root
great toe extension
S1 Nerve Root
ankle plantar flexion
What is muscle tone?
the amount of inherent neuromuscular activity present even in a resting muscle and is detected y the response, specifically the amount of resistance, to passive elongation or stretch of the muscle being tested
Hypertonia
an increase in muscle tone that results from damage to the corticospinal tract in the cortex, brainstem, or spinal cord. Clinician will feel more ressitance than you would expect normally
Hypotonia
a decrease in muscle tone that results from damage to the lower motor neuron
Clinician will feel less resistance than you would expect normally
Rigidity
an increase in muscle tone caused by damage to extrapyramidal motor structures
Spasticity
an increased resistance to passive stretch taht is velocity dependent that is often seen in conjunction with hypertonia and indicates an UMN lesions. The faster movement increases the resistance to the stretch due to an uninhibited monosynaptic stretch reflex
Grade 0 Spasticity
no increase in muscle tone
Grade 1 Spasticity
slight increase in muscle tone, manifested by a catch and release or by minimal resistance but only at the end of the ROM when the affected part is moved in flexion or extension
Grade 1+ Spasticity
slight increase in muscle tone, manifested by a catch, followed by minimal resistance detected throughout the remainder of the ROM
Grade 2 Spasticity
more marked increase in muscle tone detected through most of the ROM but affected parts are easily moved
Grade 3 Spasticity
Considerable increase muscle tone, passive movement difficult
Grade 4 Spasticity
Affected parts rigid in flexion and extension
Procedures for Sensory Exam
Patient lies in supine
Both right and left sides are tested for each site
All sites are tested for light touch and pin prick
Score = 0 for absent, 1 for altered, 2 for normal
Cervical Sensory Testing Areas
C2 = behind the ear/lateral to occipital protuberence
C3 = in supraclavicular folssa
C4 = Over the AC joint
C5 = on the lateral side of antecubital fossa just proximal to the elbow
C6= dorsal surface of proximal phalanx of thumb
C7 = dorsal surface of proximal phalanx of middle finger
C8 = dorsal surface of proximal phalanx of little finger
Thoracic Sensory Testing Areas
T1 = on the medial side of antecumbital fossa
T2 = at the apex of axilla
T3 = third rib intercostal space
T4 = fourth intercostal space (level of nipples)
T5 = fifth intercostal space
T6 = sixth intercostal space, xiphoid
T7 = slightly below seventh intercostal space
T8 = halfway between xiphoid and bellybutton
T9 = slightly above belly button
T10 = belly button line
T11 = between belly button and inguinal ligament
T12 = inguinal ligament
Lumbar Sensory Testing Areas
L1 = midway between T12 and L2
L2 = mid femur
L3 = medial femoral condyle above knee
L4 = over medial malleolus
L5 = on dorsum of foot at third metatarsal phalangeal joint
Sacral Sensory Testing Areas
S1 = on lateral aspect of calcaneus
S2 = at midpoint of popliteal fossa
S3 = over ischial tuberosity
S4/5 = perianal area
Classification of SCI
- Determine the sensory level for R and L sides
- Determine motor levels for R and L sides
- Determine neurological level of injury
- Determine if the injury is complete or incomplete
- Determine the ASIA impairment scale grade
C1-C3 Level of Injury
Muscles: SCM, paraspinals, neck
Bed Mobility: total assist
Transfer: Total assist
Standing: none
Wheelchair: need power
C4 Level of Injury
Muscles: C3 + upper traps, diaphragm
Bed Mobility: Total
Transfers: Total
w/c: power
Standing: none
C5 Level of Injury
Muscles: C3-C4, deltoid, biceps, brachialis, bracioradialis, rhomboids, some serratus
Bed mobility: some assist
Transfers: total
w/c: power or manual (needs assist)
standing: no functional
C6 Level of Injury
Muscles: C3-C5, ECRL, ECRB, Serratus, Lats
Bed mobility: some assist
Transfers: Some assist
w/c: power or manual
standing: no functional
C7-C8 Level of Injury
Muscles: C3-C6, pecs, triceps, pronator, ECU, FCR, finger flexors
Bed mobility: independent to some assist
Transfers: Independent to some assist
w/c: independent w/manual
standing: no functional
T1-T9 Level of Injury
Muscles: C3-C8, hand intrinsics, intercostals, erector spinae
Bed mobility: independent
Transfers: independent
w/c: independent
standing: typically not functional
T10-L1 level of injury
muscles: everything above and abs
bed mobility: independent
transfers: independent
w/c: independent
standing: walker and orthoses
L2-S5 Level of Injury
muscles: everything above plus full abs, and partially to full LE
bed mobility, transfers, standing: independent
High lesions and cough
muscles of inspiration and force expiration are affected
Lower lesions and cough
will have intact muscles of inspiration, muscles of forced expiration will be impaired
Functional Cough
of coughs per exhalation: 2 or more
Sounds loud and forceful
2 or more coughs per exhalation
functional significance: can clear secretion
Weak functional cough
sounds soft and not forceful
one cough per exhalation
assistance needed to clear large amounts of secretions
Nonfunctional cough
sounds like a sigh or throat clearing
no true coughs per exhalation
assistance needed for airway clearance
Abdominal Thrust for coughs
- place hand in flat fist at least 1-2 inches below the xiphoids process, centered on abdomen
- Have patient inhale/exhale twice, then apply firm upward pressure on third exhale
Modifications for Abdominal Thrust
- Anterior chest wall compression. One arm goes on chest at nipple line, second at umbilicus
- seated position for quicker resolution of congestion. Wide w squeeze in and push up
Sidelying Rotation Cough assistance
- Position pt in sidelying with supports as mecessary
- Explain that you will be providing pressure while pt tries to cough on third exhale
- stand behind pt, with one hand on AC joint and other on hip
- provide a side compression and rotation pressure with third exhale
Dose of Pressure Relief
Frequency = every 20 min
Duration = 30-90 sec
C2-C5 Level of Injury Pressure Relief
anterior trunk lean
C6 Level of Injury Pressure Relief
lateral trunk lean
C7-C8 Level of Injury Pressure Relief
cross and trunk lean
T1-T9 Level of Injury Pressure Relief
Lifting with triceps
T10-L1 Level of Injury Pressure Relief
stand/squat
Complete SCI Bed Mobility Techniques
Rolling
Supine to sit w/equipment
Supine to sit w/out equipment
Long sit
Complete SCI Rolling
They need at least triceps to perform
to decrease difficulty, cross legs or have them 3/4 sidelying
to increase difficulty, uncross legs, increase incline
Supine to sit (w/out equipment) for complete SCI
does not require triceps, uses shoulder protraction. Does require ROM of upper and lower body
- Start prone on elbows. The elbows are walked to the side until trunk is about perpendicular with hips
- Use hands to crawl farther, and then hook one arm under closest leg.
- Use other arm to push up into sitting position
Long sit for complete SCI
passive tension of the hamstrings to avoid falling
elbows go into extension, with wrists extended, fingers curled. Maintains tendonesis grip
Wheelchair transfers for those with SCI complete
Short sit
Sit pivot using head hips principle
Transfer board
Stretches for Shoulder maintenance
Behind the chair
Cross arm
upper triceps
Active movements for shoulder maintenance
Full can
ER
scapular squeeze
cross body
Resistance for shoulder maintenance
full can with weight
ER with band attached to door
shoulder squeeze, band attached ahead
cross body pull downs
